PRC – An Explanation

PRC – proximal row carpectomy is a surgical procedure that removes a row of small bones in the wrist. In reality, the surgeons change a complex joint in the wrist to a simple yet workable hinge. One good part about a PRC as compared to other wrist surgeries is that it has the least amount of recovery time. I have created a small video that explains the procedure as I understand it to be. There are many reasons why a PRC is performed and I am certain that everyone is unique. In my case my lunate bone had not received blood circulation for a very long time and had cracked while I was changing a spark plug on my Vespa GTV 300. There is no other option but a PRC or a complete wrist fusion. Have you had a PRC? If yes, please take 10-seconds and complete our survey so others may know the statistical outcome. (Click Here).

X-Rays:

CT Scan – 4 Months After Surgery:

More to Come…

Don’t give up, Mary. I dropped a lot of stuff in the early post-op months too. I taught myself how to use the other hand while I practiced trying everyday to grasp a pencil tightly with the hand that received the operation. It took me about a year before I could make a tight fist. I am 75 years old, and it has been about three years now. My hands can now both do everything equally with absolutely no pain.

66yr old female here, had CRP dec. 19 2018. it is now a week short of 3 months postop. my pointer finger has lost all strength and has a mind of its own. and cannot bend last joint at all, thumb is extremely painfull not much strength at all. i can’t even hold floss between thumb and forefinger and use it. i can’t scratch with pointer finger, no pressure in it and some loss of pressure in pinky. i also agree the braces they use seem to make thumb worse. my thumb right now is so painful to move. i can’t lift anything much with hand, not even coffee cup, and sometimes drop cell phone. but surgeon says its doing great. i’m sceptable. i can’t make a fist yet and my fingers are still swollen quite a bit. ..

Sorry to here it’s not going well yet. Male, age 69 at the time I went to surgery. (Still a male, but 73)
My hand surgeon told me that PRC was for old women who only wanted t be able to sit and hold a newspaper. Said I was way to active to do the PRC. He recommended a total wrist fusion. Said he had a friend who was a Orothopedic surgeon still cutting an sawing bones after a total fusion, He recommended that for me. That would mean total stiff wrist with no flexibility.. I opted for the
4 corner fusion where I get only about 15 degrees flexibility. i should have listened to him.

34 year old, 9 months out from my PRC. Back to surgeon today as wrist is very sore most tog the day. I’ll be getting an injection to try alleviate the pain but now back in my splint. Very disappointing and frustrating to be back to square one as regards pain and discomfort. Surgeon is reluctant to do the fusion dye my age. I’ll be getting it at some stage but not sure when. 2 years, 2 ops and soon to be 2 injections later, it’s still very disappointing as I can no longer play sport (hurling- irish sport).

Just had my PRC done in June 2018. Have found it slow going. It’s only two months but it is still pretty sore. I’ve been trying to not wear the brace but it is pretty sore typing. I have an office job so nothing manual. I’ve been back running as well wearing the brace and that does help. I have bone taken from my hip to do a non union in my scaphoid in July 2017 so it has been one hell of a year surgery wise. I’m trying to be patient with the wrist but I just want to get back to normal. I’m not expecting to lift weights or play contact sport like I was before but I’d love to get to the stage where its not stiff in the morning…..no pun intended! I can’t hold much and that is frustrating as I’m in my mid 30’s and should be more active than I am.

It is normally very slow going. I could not make a tight fist for almost a year. I had to work on it every day by trying to grasp a pencil inside a fist. You will notice they had to snip a tendon (normal hands have tendons extended to each finger). This means the three tendons on the tumb side of your hand have to be trained to pick up the slack. In the meantime, you will be dropping stuff, having trouble removing kids, and stiffness pain. It goes away though. Now my hand that had the PRC is as strong or stronger than the other hand. Be patient. I am 75 and have a grip like a vice. As for your hip surgery, 23 days ago I had the Birmingham hip resurfacing surgery. I am having to strengthen the tendon connecting my femur bone before I can ditch my crutches and be able to do my morning runs again.

Keep up with your hand therapy and strengthening. It will take time but you will feel better. I’m 29, and had PRC in July of 2017. They were going to perform VBG but the scaphoid was already too shattered from a previous injury. Now I’m 1 yr and a month post PRC, and i feel it’s still healing. I don’t have stiff hand in the morning and in general i’m pretty pain free. I still feel it sometimes if I strain it too much, but I’m hoping that too will get better in time. This really is just a very slow process for healing. And the progress is in small steps. up until about 10 months post surgery I had a lingering pain on my pinky side of the hand, which is now pretty much gone. Don’t give up! you’ll get back to a lot of what you were doing before. Just be patient (I know, easier said than done ;))

12 weeks post op. Still wearing brace pretty much 24/7. Started strengthening week 8, but still can’t lift more then a pound without brace. Sometimes that’s even challenging…..drop a lot of stuff😔Constant pain in wrist, not like before surgery, but still pain. Wrist swells almost every day after work. I can’t say I’m not totally confused and depressed at this point. Not much online about prc. This is just me looking for answers to a question that has no answer. Will I ever be me again, normalish? Will my wrist always have a weird hump? Will I ever be free of this brace? Sorry, I’m just fed up with such little and no current info. Thx for listening to my thoughts.

Don’t be discouraged. I am 75 years old, and had the operation about 4 years ago. Now that wrist is stronger than my other wrist. I spent almost an entire year trying to have a clenched fist capable of grasping a pencil tightly. I practiced every day. Eventually, I could close the fist entirely. I dropped lots of things along the way—couldn’t even screw off jar lids. Now no problem! I routinely workout with 75 lbs. I can do 10 repetitions of 10 lb wrist curls with 90% effort.

Thank you Larry! That’s helpful and encouraging. I’m finding this a tough surgery to “come back” from…. mentally and physically. My surgeon said it was a quick recovery but I’m not seeing it. I do my at home therapy every day and go once a week to OT since I’m back to work 6 days a week. I guess I’m just so frustrated…..but you made me feel a bit better knowing it’s “normal” progress. Thank you again!

You hang in there I am a dibble PRC Patient and I am still awaiting another surgery on my right wrist Unfortunately the bone that was removed keeps growing back it is a very rare thing in but it does happen I am proof of it I have had the bone come back 2 times in my right wrist and 2 times it’s been removed my left wrist is awesome I have no pain and can do so many things with it so when you think that you’re really badd there’s always someone worse so hang in there you got this don’t give up I haven’t and I’m still pending a surgery

Perhaps I am an exception. I had PRC about six years ago on my right wrist. I have absolutely no pain and I have total flexibility. It took over one year for the normality, but I am very glad I had it done. I am 75 and I can throw a baseball or football with my grandchildren. I am a community coach for a high school wrestling team. I workout daily with weights.

I had mine done several years ago and I don’t notice it at all. It was very painful at first but now nothing. I had the other wrist fused before that and I am so used to it that I never think about it. Hang in there.

I had PRC done 10 months ago. I’m pleased with the range of motion, and I don’t usually have pain in my wrist. However, I am constantly aware of my wrist, and it just feels abnormal all the time. It kind of feels like a soreness or fatigue after overusing it, except even if I don’t actually overuse it. I know the wrist will never feel completely normal, because it’s not a normal wrist anymore. But what are some things that I can do to help with the strange sensation? does it get better with time?
It can get frustrating when I’m not focused on anything in particular, and then my mind goes directly to thinking about this strange feeling in my wrist.
Thanks!

Wait until you’re ready and then get the full fusion. It is not worth worrying about your hand all the time. What you lose in range of motion is easily overcome. In fact I don’t even notice it and the rest doesn’t feel “different“. I just need a little help getting something off a high shelf but that’s all I really notice. I really discourage anyone from getting this procedure done. If you have it done like I did, it’s not too late to get the full fusion. By the time I did it my hand was completely off center because the rest was so unstable.

i had a prc done 6 years ago, i am 51, so now i look into the fusion as i am in pain every day, i am a custodian in a high school maybe they can cut my hand off and attach a small wall washer, lol. fuck!

I hate you are in pain. Don’t wait on the complete fusion. I had the same concerns about not being able to move my wrist. It is a complete non-issue. I never even think about it and the pain level is near zero. I wish I had started with the fusion and was not talked into the PRC. I hope you feel better.

I cannot stress highly enough that this procedure is not worth the perceived gain in range of motion. It kills grip strength, has an incredibly long and painful recovery process and ultimately your hand will be unstable. Skip this dangerous surgery and opt for a complete fusion. Recovery is quick, pain is gone, grip strength remains largely intact and what little disability there is can quickly and easily be compensated for to the point you don’t notice it.

I had the prc done 4 yrs ago and am so happy with the result. I injured my wrist at work and it didn’t heal properly and cut off the circulation to the scaphoid bone. I am a professional guitar player and it hasn’t affected my playing. I have no pain and hardly notice the loss of motion

My comment was in regards to my PRC about two years ago. I am sure mine will be fused later. I feel like arthritis has started to set in. My surgery was from a bad wrist fracture that never healed correctly.

Do not get a PRC. The surgery is painful, hard to recover from and the rehab last a very long time. Your hand will never be the same in terms of range of motion or grip strength. Opt for the complete fusion. It causes minimal changes in lifestyle, the recovery time is fast, and the pain dated day is nonexistent. The PRC method makes the promise of a range of motion which in some ways you get however the loss of grip strength and pain involved is not worth it.

I was diagnosed with end stage 3 in October. I chose not to do anything about it as the pain was something I could handle with daily Aleve. My GP put me on 300 mg of gabapentin for both my insomnia which also takes care of the pain till mid day. I’m not ready for surgery but I do worry that I might be causing further damage to the rest of my hand. Has anyone else just managed the pain and gone on? I’m 63 and not ready to lose range of motion.

I am one of those who decided against surgery. I was diagnosed with stage 1, two years ago, when I was 52. I was in a lot of pain at the time and was considering surgery but as a lifelong guitarist, and working musician, I was afraid of losing my abilities. At the time, I really couldn’t play without pain. I decided on a number of changes: 1. I changed my diet and excluded gluten and all processed foods; 2. I started taking flax oil, borage oil, and fish oil supplements daily; and 3. I began swimming three times a week. Oh, the other major change was that I changed the way I used my right hand. I stayed away from any activity that would stress my hand/wrist. After about 6 months, I started to notice some changes. I no longer had appreciable pain, had good range of motion, and I was able to play the guitar without any pain. I still can’t lift heavy things or work with tools the way I once did, without pain, but for me, it has been worth it. I still sometimes tweak the wrist and it takes a few days to calm down. I may need the surgery in the future but I’m not there yet. I was told by my surgeon that waiting could cause more damage because of the progressive nature of SLAC, but more importantly I think, that the decision to have surgery is really a matter of quality of life. For me, what I am doing now is working.

Thanks very much for the information. I play guitar also and golf. I am right-handed and the pain is in my left wrist but the left wrist is critical for guitar and for golf. I can manage my pain with diclofenac, a strong anti-inflammatory, so I will hold off on the surgery for now and try the dietary changes u recommended. Brian

My range continues to get smaller as time goes on and the pain getting worse. The injections don’t last and the ibuprofen is making me feel sick. My PRC is scheduled for 2weeks from tomorrow (2/25/19).
I am VERY apprehensive but fear the total fusion more. I am still working and do not know what to expect from a recovery perspective. How long before I can resume normal office type work.

March 17, 2016 was my surgery and I am one year post PRC today! I work as a nurse in an Emergency Department and I have full functioning of my wrist and hand. Fine motor skills are spot on (starting IV’s, suturing, etc.) and I can do CPR (chest compressions) and lift/move patients with no trouble at all. My work performance is not impacted at all. My limitation is in the gym, I still have a bit of decreased range of motion (ROM) which makes it difficult to do bench presses and I am not able to do a traditional push up yet, both things I was doing prior to the surgery even with the fractured, non-healing lunate bone. I was having constant pain and losing hand strength prior to the PRC, so the small loss in ROM is worth it. I have no pain now and my hand strength is just as good as it was before.

Hi,
I had my second surgery (PRC) for Kienbock disease Nov. 30 2016. I have fairly good movement but stiffness with some pain when I bend my wrist forward when I make a fist . My question is this . I have a knot on top of my hand close to my wrist that the Doctor says is scar tissue . I also have a “dip” area in my hand I imagine where he removed the 3 bones in my hand . It looks sort of deform compared to my other hand .
Does anyone else have this after PRC surgery ?
Thanks,
Linda

I’m having the PRC in 2 days. Dr Moore Wilmington, N C. I’m very impressed with him, but depressed reading these posts. I’ll be 64 a couple of days after the surgery and moved here 9 months ago, a golf community. scary the length of time for recovery. I too lift wts, and run (falling on runs obviously was the cause) and moved here to learn and play golf. a lot of this sounds like bad news.

I am 74. I had it done when I was 71. I lift weights and coach a high school wrestling team. It takes a while before you get the tight, strong grip back into your hand. However, now I can hardly tell any difference between both hands. It was the best decision I ever made.

Tom, I am 61 and surgery was 5 weeks ago. Cast came off 1 week ago and had physical therapy yesterday. Some pain but not too bad. already riding motorcycle. Being aggressive after cast was removed seems to lessen swelling and pain.

I had my prc done on dec 19th and i am still in significant pain and swelling, also my hand seems to be shaped much differently than i thought. My pinkie is offset and im not sure if all of this is normal. My doctor told me i could return to work 2 weeks after surgery so i didnt plan to have more time saved to make sure i get a paycheck so i had to return 3 weeks after and cant do everything i should as a correctional officer so i may have to go on leave without pay.

Hello my name is Paul I am a double proximal row carpectomy patient and just recently on December 6 have a Nother surgery to remove a bone that grow back it doesn’t seem possible that you would return to work into weeks or three weeks after this kind of surgery you should have been casted for over a month and then have to go through a lot of physic therapy I think you should seek a second opinion because something just doesn’t sound right I was off for nearly a year after each surgery and it takes quite a long time for the pain to subside my advice is that you seek a second opinion and get a cast on that hand immediately

I have had a PRC in addition to a complete fusion of the wrist. I highly discourage the PRC. It causes a lot of pain, extended down time and months of physical therapy. Then you have reduced range of motion, and near zero grip strength. In contrast, the fusion fixed the pain, recovery time minimal and grip strength remained. Of course you sacrifice ROM but it is an easy adjustment. I have returned to lifting weights without restriction.

Hi,
I had a PRC on Nov. 30th. I still use a removable cast but did start PT this week
. Does or has anyone experienced an enlarged knuckle below the index finger? Also I have what the Dr. says is scar tissue which looks like a knot on top of my wrist.Has anyone had that and if so did it go away ? My Dr doesn’t think I’ll have any more than 50% range of motion.Im ok with this as this is my second surgery I had my lunate revasculated and the ulna shortened in 2012 and only got about 50% range back then after 5 months of PT ,

I also have the large knot on the top side of my wrist and hurts if press on it and a large place on the bottom of wrist that hurts most of the time I don’t think it is going to go away on its own but I will not have any more surgeries this past 9 months has did in for sure

George, I did not experience much pain at all. The one exception was when I would sleep at night. I had a bad habit of laying my head on the wrist. It would hurt in the morning. I solved that by placing the pillow between my wrist and my head. I had my surgery over two years ago, and if I sleep wrong, to this day, I will experience some pain in the morning. Otherwise, I never have any pain.

I scheduled surgery for wednesday with the plans of returning to work the following Monday. Didn’t work out. Couldn’t tolerate the pain without meds. I sit in front of a computer all day. Returned the following Monday but had trouble then. It has been almost 2 months. Still a lot of pain, but tolerable. Much better than it was before surgery. Taking gabapentin for back pain which helps a lot. A 2lb weight restriction so not sure how I would return to work if doing physical labor. Good Luck!

Had PRC March 24 2017. Pain for first 24 hours. Cast was removed one week ago. First therapy session was yesterday and I rode my motorcycle there. Dr. who performed surgery has done many. After surgery he said it went perfect. Range of motion today is about 80% of what it was previously. Reason for surgery was a fall and fracture 20 years ago. Have some pain mostly because I’m pushing it beyond limits so as to get back as best that I can.

i don’t know what you do for work but returning in a week. wow. i couldn’t do anything in a week. i’m 3 months post op and still lots of pain in underside of wrist, top of wrist, fingers that no longer respond. no strength in 3 fingers, still swollen and can not make a fist. just doing dishes is a huge chore and causes a lot of pain. good look but i think you need more recovery time.

Hi everyone my name is Paul I had a PCR in both left and right wrist I’m doing very well in my left wrist but something crazy happened to my right wrist one of the bones grew back and I am having it removed on December 6 it is very rare but it happens my sergon was totally shocked he had only heard of this in books and now it’s in his face I don’t know what to think of it but I have to deal with it wish me luck next week

I had a prc about 7 months ago. I’m lifting weights..As the one poster said I too am lifting less weight with more reps. I had an awesome surgeon and physio guy. They said two years until one can fully judge the results. Range of motion in flexion is a problem but I’m almost up to about a 50 degree angle. I hope to improve this further. I’m in law enforcement and the surgeon thinks I wll be able to eventually continue my work. BTW I broke my scapoid about 15 years ago, and again 12 years ago…it was not treated.
Dr. Morhart in Edmonton is a genius!

I lift weights too, Garth. I am a high school wrestling coach. It took me almost 18 months before I could make a tight fist and have total range of motion. Now, a little over two years later, the wrist functions 100% like my other wrist.

Garth how long were you out of work? I am also in law enforcement and have not yet gotten the surgery. They are not sure yet how to proceed, since they have never seen anything like it. I somehow shaved the cartilage off the lunate bone. So right now the choices are the PRC or the fusion. I dont think fusion is an option at this point due to my career and also my hobbies.

I had a PRC a little over a year ago. I had a bad wrist fracture I can do most things or I have adjusted. I used to do a lot of bicycling, but now it’s difficult. My range of motion is very limited. The pain is better then before the surgery. Its harder to get off the floor with my wrist. I use more my elbows. My injury was from a fall – workers compensation. My wrist has been a lot weaker ex: opening a bottle of pop. Its a life adjustment. I have huge fears I may fall again and bend wrist beyond my range of motion. I would think it would,be very painful.

I had that same fear for the first couple of years. I have since fallen a few times and somehow my body managed to avoid injuring my wrist. I still ride my motorcycle and now I am training for Style Canoeing and love it. It is hard on my wrist by I recover daily and need to pain meds at all.

Dew, I had trouble twisting lids off of jars, and I had limited strength and range of motion in my wrist for about 18 months. It has been two years now, and everything is back to normal. I think it just takes time for the body to recover and make new adjustments.

I too opted for the 4 corner fusion 11 months ago. Arthritis set in and it hurt like before the operation. A month ago I had orthroscopic surgery to scrape the bone.
Now I want the full wrist fusion with a steel rod. This business of having to baby it is not acceptable. Just like the doctor said, the PRC and 4 corner fusion are for light use only,

hello everyone. i am very happy i found this page. i am a 23 year old college student who recently had PRC due to Kienbock’s. reading every ones replies i know the recovery time is a long process but i was wondering if anyone can still lift weights? (even years after recovery?) working out is a second way of life for me and never being able to do it again might just ruin mine. i knew going into surgery i would never be able to do certain movements after and not be as strong but im really worried(even if it is very light lifting). if anyone could can help out or give some advice that’d be great..

Quick Hx – broke my wrist boxing and playing football years ago which resulted in wrist instability and requires multiple surgeries. Had an unsuccessful bone graft done and then a PRC. The PRC helped with pain but the recovery time was long and painful. Eventually returned to being able to about 70 % strength in my hand and probably 60-70% range of motion. However, eventually pain returned over the course of several years and the wrist became unstable. This resulted in a complete fusion of the wrist. If I had a chance to do it again, I would opt for the fusion. I was scared to death of not being able to move my hand but I really don’t even think about it. It’s a non issue 98% of the time outside of typing moving things into a shelf. Pain is near zero unless I over use my hand, then I use a brace till it recovers. One thing to note is that my job requires some heavy lifting and I still weight train. I do not take it easy on my hand and if your job and lifestyle are more casual, a PRC may work for you. If I had to do it again, I would skip the PRC and opt for the fusion.

With the complete fusion, it took about 18 months before I could lift weights without restrictions and no brace. Since that time, I have had no issues lifting. I do have to modify the movements on a couple of the machines because my hand won’t bend but truly it is a minor inconvenience. They offered to do a complete fusion first but I was talked into a PRC by the surgeon with a promise of wrist movement. The recovery from the PRC was long, painful and there was still instability. Eventually my hand shifted out of alignment. My advice is to skip the PRC and opt for the complete fusion.

HI Chris, thanks your reply, u have absolutely made my day ! I have no intentions of having a PRC, its a full fusion for me, no messing about and no future surgeries. Do you do any free weights in the gym or machines only?

I use mostly machines but I do some free weights too. That is by choice though and not a limitation of my hand. Bench press can be a little awkward especially heavier weights. Push ups just need to be done on your knuckles instead of your palm. Use correct form when doing pull ups. Other than that, no issues. There is a small adjustment period while lifting. The limitation is really an inconvenience and not a serious functional limitation. Pain level 0 on most days.

On the machines I use the max weight or close to it. That includes machines for chest, back, Lats and Bi’s. Legs I use free weights because most machines don’t carry enough weight. Bench press free 225-250. Don’t want to over due it. I’m not 25 anymore. Lol Hope it helps! Good luck.

You can do db press but you need to rotate the weight to accommodate your hand. I use my good hand for support. You can lift whatever you want, but you will need to adjust a little. It comes prettty naturally though. Last bit of advice – let it heal and get the all clear from your doc before lifting. It took 18 months to lift with no support brace. (It took 10 months before I could 3 even bend my hand after the PRC much less lift anything over a few lbs). It takes up to two years for the fusion to be seen on an x ray. I have lived through both and you are making the better decision with the fusion!

I am 73 years old, had the PRC a little over two years ago. I still work full time at a local high school and in the evenings, I am the high school wrestling coach. I still lift weights and I am able to demonstrate the wrestling techniques with my wrestlers. I do not try to see how much I can bench or anything like that. I usually do not use more than about 75 pounds for lifting that requires wrist strength. I keep a tricep bar with 75 pounds on it in my class room. We do an exercise called 7-7-7 with the bar on a regular basis. It provides a good break from the math and physics, and keeps me in shape. It took me almost a full two years before I could handle this sort of thing without any pain.